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Self-management of asthma in general practice, asthma control and quality of life: a randomised controlled trial
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  • Published on:
    Author's reply to Dr Martin Olmedo
    • Bart P Thoonen, General Practitioner
    • Other Contributors:
      • Tjard Schermer, Chris van Weel

    Dear Editor

    In a reaction to our paper Dr Martin Olmedo asks what factors may explain the observed better control of illness in our self-management group.

    The self-management program in our study consisted of education, skills training and written instructions for autonomous adaptation of maintenance therapy with inhaled corticosteroids. As this intervention consisted of more than one element, it is n...

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    Conflict of Interest:
    None declared.
  • Published on:
    Author's reply
    • Bart P Thoonen, General Practitioner
    • Other Contributors:
      • Tjard Schermer, Chris van Weel

    Dear Editor

    In their response to our article Dr Griffiths makes some important remarks, which we would like to comment on.

    We did indeed take clustering into account in the analysis of our data. As stated in the methods section of our paper we used multilevel models.[1] In this multilevel model practices were included as the level of clustering in these models.

    A second methodological questio...

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    Conflict of Interest:
    None declared.
  • Published on:
    Re: Self-management of asthma in general practice, asthma control and quality of life

    Dear Editor

    I would like to ask the authors a question:

    In the results we can observe that the control of illness is better in the SM group but you say also that there were a saving in inhaled corticosteroids.... so how can you explain the best control? May be the environmental control or there are others explanations?

    Conflict of Interest:
    None declared.
  • Published on:
    Self management of asthma in primary care
    • Chris Griffiths, Reader in Primary Care
    • Other Contributors:
      • Sandra Eldridge, Senior Lecturer in Medical Statistics

    Dear Editor

    Evidence that self management programmes for asthma are effective in primary care is elusive.[1] Thoonen and colleagues have carried out a complex and impressive cluster randomised trial from which they conclude that a self management programme implemented in Dutch general practices lowers the burden of illness.[2] Parts of their analysis require comment.

    It is not clear whether clustering has bee...

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    Conflict of Interest:
    None declared.